Provider Demographics
NPI:1548592298
Name:BELCZYK, KELLY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BELCZYK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5142
Mailing Address - Country:US
Mailing Address - Phone:541-317-3173
Mailing Address - Fax:541-330-4642
Practice Address - Street 1:1128 NW HARRIMAN ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1947
Practice Address - Country:US
Practice Address - Phone:541-330-4637
Practice Address - Fax:541-330-4642
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL54401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health